Vytalize Health

Affiliate Manager

• Creates a customer-focused, provider experience by listening to the customer and providing timely, clear, and consistent communication.
• Address grievances
• Provider Education
• Provide expertise and resources on issues affecting provider satisfaction and network retention. Conduct research, analysis, and coordinate timely resolution of complex provider concerns and appeals by engaging directly with providers and internal partners.
• Creates customer loyalty and improves retention by establishing and maintaining positive, collaborative relationships with providers and their office staff through proactive communication, delivering exceptional service, and prompt resolution of issues.
• Represents the organization in a positive and professional manner.
• Communicates effectively and efficiently both verbally and in writing.
• Provides accurate and updated information to providers.
• Responds timely (within department standards) to provider issues, works with other teams to resolve issues, and updates providers and office staff regularly through to resolution.
• Collaborates with internal stakeholders and other subject matter experts (ie credentialing, roster management, etc.) to effectively resolve issues.
• Performs high-quality work following standard operating procedures, ensuring accuracy and consistency in all interactions.
• Escalates issues following department guidelines to ensure timely resolution and customer satisfaction.
• Resolve customer interactions on the first call or contact when possible.
• Researches and uses problem solving skills to answer questions accurately and timely.
• Documents issues addressed and monitors for trends.
• Performs high quality work following standard operating procedures.
• Escalates issues following department guidelines.
• Performs other duties as assigned.

Partner Relations Specialist

Manager

• The RN Case Manager works with the clinical department and acts as a liaison with our physician practices.
• The RN Case Manager advocates for personalized treatment options that address a patient’s unique care needs.
• You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs.
• You will deliver patient-centered care, provide exceptional customer service, and work within your scope of practice to provide evidence-based education, assessment, and care navigation.
• Identify patient/caregiver education needs through telephonic assessment/engagement and ensure that the patient/caregiver has adequate information to participate in the successful transition back to their home setting from an inpatient or post-acute facility stay.
• Conduct timely telephonic clinical outreach to identified patients.
• Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home.
• Serve as the point of contact and informational resource for patients, care teams, family/caregivers, payers, and community resources.
• Implement interventions that improve health outcomes, lower costs, and enhance the patient experience.
• Work collaboratively with provider offices, SNFs, hospitals, and other Clinical Services teams to support each patient’s needs efficiently and effectively.
• Assist in coordination across the continuum of care while maintaining confidentiality.
• Guide patients through the healthcare system and help them overcome barriers.
• Coordinate treatment and services for patients.
• Schedule medical appointments as needed.
• Communicate about a patient’s health condition with the patient and their family.
• Provide community resources to patients as needed and support resolution of SDoH.
• Maintain a comprehensive working knowledge of community resources.
• Assume accountability for the quality of care.
• Continually seek new knowledge and learning that supports clinical care coordination.
• Depending on market location, minimal travel may be required to visit provider offices to help enhance provider office engagement (less than 5%).

RN Case Manager

Financial Planning and Analysis

• Review and evaluate active payer contracts across Medicare Advantage, Commercial, and Medicaid lines of business
• Assess contract language, risk level, shared savings / quality / PMPM terms, data specifications, financial implications, and accounting treatment
• Evaluate new contracts: analyze historical performance, model go-forward financial implications, and make recommendations
• Integrate new contracts into existing reporting, performance monitoring, and accounting processes in collaboration with payer contracting and operations teams
• Pull and consolidate payer reporting to assess contract-level financial performance (revenue, expense, MLR)
• Produce performance summaries and guidance for senior leadership and investors; escalate issues and variances as needed
• Track impact of advance cash mechanisms on revenue vs. cash treatment
• Present findings to senior executives, provider partners, and payers (e.g., provider JOC meetings, NOMS leadership)
• Actively participate in JOC and other monthly payer meetings; own performance tracking and follow-ups
• Serve as point of contact for payer-reported financial data interpretation
• Manage claims processing where applicable (e.g., Anthem MA Ohio)
• Summarize performance across all contracts and provide information flow to accounting
• Interpret payer-reported data and recommend accounting entries (revenue, COGS); propose journal entries based on reported performance
• Advise on approach to book financials given claims lag and delayed payer reporting
• Report on actuals and full-year projections as claims runout data and payer reporting become available; provide financial inputs to accounting
• Own private payer budgeting: short-term and long-term planning
• Produce and maintain budget vs. actuals reporting
• Provide strategic financial insights and contracting recommendations
• Walk through program, payer, and provider contracts with auditors
• Document revenue projection processes for in-year and future-year performance
• Assess stop-loss policies and pricing; report claims to insurance provider and manage communication for timely recoveries
• Interact with third parties (reinsurers, underwriters, actuaries) to interpret results and assess impact on performance outlook
• Provide stop-loss results to accounting
• Partner with medical economics team to analyze claims and financial data to identify savings opportunities
• Support final practice-level shared savings payouts across functions
• Serve as SME for value-based contracting across accounting, finance, data & analytics, operations, legal & compliance, and network teams
• Participate in private payer underwriting workgroup and provide input on MA incentive payment structures
• Ad-hoc participation in investor meetings to present contract financial performance and outlook
• Support claims validation and QA: data ingestion, normalization, and comparison to payer financial reporting

Partner Relations Specialist

RN Case Manager

Senior Director of VBC Finance